GP registration in Hackney, the right to access health care (third review)

Healthwatch Hackney wanted to follow up their initial report on GP registration in 2021 and their second review of the topic in 2022 with another review in October and November 2022.

Healthwatch Hackney volunteers anonymously telephoned all the 38 GP practices in Hackney to enquire about the new patient registration process posing as a service user or a friend of the service user. Each practice was called twice.

Two volunteers also physically visited two GP practices as ‘mystery shoppers’. The two practices were selected among those who told us that proof of ID and or address was required for registration. One of the practices was consistent in its approach throughout the 3 reviews. The other practice demonstrated a negative change in comparison with the last review in October 2021.

Practices were contacted again in December 2022 by volunteers on behalf of Healthwatch Hackney. Healthwatch decided not to place extra burden on GP phone systems during the morning peak opening times/busy period. Therefore, on both occasions, they made calls between 10am and 5pm and avoided the lunchtime period as many practices close during this time. Before each of the calls, they identified a postcode close to the GP practice to be contacted. This was to ensure that if the caller was asked for their details, they could provide a postcode within the practice’s catchment area so that registration could not be refused on the basis of catchment area.

• Healthwatch found that the majority of practices asked for the caller’s address before answering questions, to check that they resided in the practice’s boundary area.
• 84% of the practices did not require proof of ID/address for registration. One practice had closed its patient list but still confirmed that no proof of ID/address would be required.
• 16% (6 out of a total 38) of the practices required proof of ID and/or address to approve registration.
• On all occasions during the mystery shopping calls, the questions were answered by the person who picked up the call.
• When calls were made on behalf of Healthwatch Hackney, questions were responded to by the receptionist on 37 occasions, with one conversation taken over by a practice manager.
• Throughout both exercises, holding the line waiting for the call to be picked up took anywhere between 4 minutes to over an hour on a few occasions.

Compared with the last review (October 2021) the calls made for this review showed that:

• 25 practices were consistent in their approach of not asking for proof of ID and/or address for registration
• 7 practices made a positive change to their registration policy and no longer required proof of ID and/or address for registration (compared to October 2021)
• 5 practices had made a negative change to their registration policy and were now requesting proof of ID and/or address for registration (compared to October 2021)
• 1 practice remained consistent in its approach of requiring proof of ID and/or address for registration

The report identified GP practices with good practice and those which required improvement.

Healthwatch Hackney shared the initial findings with NEL ICB who contacted those GP practices that required improvement for their responses.  Healthwatch Hackney followed up these six practices with further mystery shopping calls.  Four said that no ID was needed to register, whilst the other two still required the applicant meeting the practice manager.  Healthwatch Hackney set up a meeting with the 6 practices and the ICB to discuss how to address the situation.

The report contains a number of recommendations aimed at improving registration processes at GP practices.